Gallbladder Empyema Research Articles

Endoscopic Findings of a Patient Having Cholelithasis in SOMCH, Sylhet, Bangladesh

Introduction: Cholelithiasis is one of the most frequently encountered disease and one of the major causes of abdominal morbidity throughout world [1]. Cholelithiasis is one of the most common and costly of all digestive diseases. Common causes of upper abdominal symptoms are peptic ulcer, acute and chronic gastritis and gallstones. Objective: To assess the endoscopic findings of a patient having cholelithasis in SOMCH. Methods: This was Retrospective Hospital based study conducted at Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January to December 2022 were (One hundred patients were included). All patients underwent OGD after being diagnosed as having cholelithiasis proved by Endoscopic. All patients above 18 years of age presenting with upper abdominal pain, dyspepsia with or without jaundice diagnosed ultrasonically as cholelithiasis and choledocholithiasis with cholelithiasis were included in the study and patients managed conservatively, patients with primary choledocholithiasis and with asymptomatic gallstones were excluded from the study. Results: Out of 100 subjects evaluated during the study period, 58 were females and 42 males. The most common age group affected was between 31-50 years (65%), followed by less than 30 years of age being 18% and more than 50 years being 17%. It should also be noted the higher rate of incidence (65%) in the age group of 31-50 years. Associated symptoms with cholelithiasis were pain in abdomen, which was observed in all the patients (100%). Of these, 74 patients (74%) presented with chronic upper abdominal pain and 26 patients (26%) presented with acute upper abdominal pain. Remaining 56% of the subjects had positive endoscopic findings. Endoscopic findings were positive in 56 had hiatus hernia, duodinitis, duodenal ulcer or other positive findings. Among patients with positive findings 14 had both oeophagitis as well as gastritis while 12 had both gastritis as well as gastric ulcer. All the 56 patients (100%) underwent surgery. Forty patients (71.4%) underwent laparoscopic cholecystectomy, 14 (25.0%) open cholecystectomy and 2 cholecystostomy for empyema gall bladder. Of the 56 patients 40 patients (71.4%) patient had chronic cholecystitis, 9 patients (16.07%) had acute cholecystitis, 4 patients (7.14%) had carcinoma gall bladder, 2 (3.57%) had xanthogranulomatous cholecystitis and 1(1.78%) had cholesterolosis of gallbladder. Of the 4 patients diagnosed of carcinoma gallbladder, 1 patient had carcinoma confined to muscularis mucosa with negative margins and no metastasis, hence no further surgical management was advised and the rest of the 3 patients had either metastasis or positive margins which were managed as per standard guidelines. Conclusion: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Endoscopy the most common finding was gastritis, oesophagitis and gastric ulcer in decreasing order. There was no hiatus hernia, duodinitis or duodenal ulcer in our study. Patients presenting with dyspepsia and gall-stones in rural setup should be directly treated surgically. Multiple gallstones are common and Laparoscopic cholecystectomy offers best surgical management with 6.57% of conversion rate to open cholecystectomy, with lesser complications.

Role of Indocyanine Green (ICG) in the Management of Acute Gangrenous Cholecystitis Secondary to Gall bladder Empyema in Mirizzi's Syndrome: A Case Report

Role of Indocyanine Green (ICG) in the Management of Acute Gangrenous Cholecystitis Secondary to Gall bladder Empyema in Mirizzi's Syndrome: A Case Report

Double trouble: an unusual case of Klebsiella pneumoniae invasive syndrome with liver abscess, gallbladder empyema and infective endocarditis

BackgroundKlebsiella pneumoniae invasive syndrome (KPIS) is characterized by primary pyogenic liver abscess associated with metastatic infections. Although rare, Klebsiella endocarditis carries a high mortality risk.Case presentationA 60-year-old lady with type II diabetes mellitus presented with fever, malaise, right hypochondriac pain and vomiting for two weeks. Ultrasound abdomen revealed a collection within liver, and distended gallbladder with echogenic debris within. 3 days after ultrasound guided pigtail drainage of gallbladder empyema, newly presence murmur detected. Pus, urine, and blood cultures obtained were positive for Klebsiella pneumonia. Echocardiogram exhibited oscillating mass attached to anterior mitral valve leaflet. After 6 weeks of intravenous ceftriaxone, follow-up echocardiogram and ultrasound showed complete resolution of mitral valve vegetation, hepatic and gallbladder collection.ConclusionConcomitant extrahepatic infective endocarditis (IE) should raise concerns in daily practice for patients with Klebsiella pneumoniae liver abscesses, despite the rarity of Klebsiella endocarditis. In the absence of diagnostic suspicion, antibiotic treatment regimens may be shortened, and adverse effects from IE infection may ensue.

An Audit of Laparoscopic Cholecystectomy.

Objective: Gallstones is a common problem, particularly among women .In modern medicine, uncomplicatedgall stones are usually treated with Laparoscopic Cholecystectomy “Key-hole Surgery” .It carries significantlylower morbidity and mortality as compared to open surgery . At Muhammad Medical College Hospital (MMCH)we have started the procedure in recent years. .Aims: To look into various demographic and clinic aspects of Laparoscopic Cholecystectomy done at MMCH.Methods: Retrospective audit of record of last consecutive 99 patients undergoing Laparoscopic Cholecystectomy at MMCH. Research Ethics Committee approval was obtained (No.250811/REC/003).Results: 33 Men and 66 women underwent this procedure. Average age was 45 year (range 16 to 75). Commonest presenting symptoms were Nausea/vomiting (n=36) and abdominal discomfort /pain (n=36). All patientshad pre-procedure ultrasound scan showing gall stones .At surgery, 99/99 were confirmed to have gallstones .Although 9 also had adhesions, 6 were acutely inflamed and 3 had empyema gall bladder. There were 2conversions Average duration of stay in hospital after procedure was 9 days (range 3 to 20). 2 patients hadwound infection and 3 atelectasis. No mortality was seen.Conclusions: Laparoscopic Cholecystectomy is a safe procedure for gall stones disease.Keywords: Laparoscopic cholecystectomy, conversion rate morbidity.

Acute Cholecystitis Due to Lactococcus lactis and Single-Center Experience With Infections Due to Lactococcus spp.

Background: Lactococcus species are used to ferment milk to yogurt, cheese, and other products. The gram-positive coccus causes diseases in amphibia and fish and is a rare human pathogen. Patients and Methods: A 51-year-old male underwent laparoscopic cholecystectomy for acute and chronic calculous cholecystitis. Lactococcus lactis was isolated from pus from his gallbladder empyema. Results: Our institutional database was searched for other cases of Lactococcus spp. infections and four patients (2 males, 2 females; aged 51, 64, 78, and 80 years) were identified during a four-year period. The three other patients had positive blood cultures associated with pneumonia, toxic megacolon, and severe gastroenteritis. All isolates were monocultures with Lactococcus lactis (2), Lactococcus garvieae (1) and Lactococcus raffinolactis (1). Two patients died related to their sepsis. We report the second case of cholecystitis involving Lactococcus. Conclusions: Lactococcus is a very rare pathogen mainly causing blood stream infections but needs to be considered to cause serious surgical infections in humans.

Laparoscopic subtotal cholecystectomy outcomes across a low-and middle-income country metropolitan health service.

Laparoscopic subtotal cholecystectomy (LSC) is a safe alternative for difficult cholecystectomies to prevent bile duct injury and open conversion. The primary aim was to detail the use and outcomes on LSCs. Retrospective analysis of a prospectively maintained database of laparoscopic cholecystectomy (LC). Relative clinical factors, outcomes, and 30-day follow-up between LSC and LC were compared using univariate and multivariate analyses. Six hundred and twenty four cholecystectomies were performed and 53 (8.5%) required LSC. 81.8% were fenestrating LSC. Male sex was significantly overrepresented in the LSC group (p<0.01) and patients requiring LSC were significantly older (p<0.01). Same admission cholecystectomy was associated with a higher risk of LSC (p<0.01). Patients with a history of previous surgery, preoperative ERCP, or percutaneous cholecystostomy had an increased risk of undergoing LSC (p<0.01). A necrotic gallbladder was the most significant predictor of the need for a LSC (p<0.001). A contracted gallbladder, extensive adhesions, gallbladder empyema, and severe inflammation were significant predictors of difficulty (all p<0.01). Postoperative complications occurred in 26.4% of LSC patients. There were ten (18.9%) Clavien-Dindo Grade III complications, 5.7% required ERCPs, and 9.4% required relook laparotomies. Significantly, more patients in the LSC group developed bile leaks (n=8, 15%) (p<0.001). There were two readmissions within 30days, one mortality, and no BDIs occurred in the LSC cohort. LSC provides a feasible surgical option that should be utilized in complex cholecystitis.

CONVERSION TO OPEN CHOLECYSTECTOMY - A SAFE ALTERNATIVE, NOT A FAILURE!

Background: Understanding factors that predict conversion in laparoscopic cholecystectomy (LC) to an open procedure is important as it allows better patient selection, preparation, operating list planning, referral, counseling and lowers the threshold for a safe conversion, thereby minimizing undue prolongation of attempts at laparoscopic completion and inadvertent complications.Methods: Records of 1010 consecutive patients who were taken up for LC, at a tertiary care teaching institute in northern India, were reviewed retrospectively. Preoperative and intraoperative characteristics of patients who underwent a successful LC were compared with those who required conversion to open surgery.Results: The conversion rate was 7.5% (76 patients). The most common reason for conversion was the inability to define the ‘Critical view of safety’ in 48, (63%) of patients. Other reasons included dense peri-cholecystic 9 (12%) and intra-abdominal 8 (11%) adhesions, suspicion of bile duct injury 4 (5%) or malignancy 3 (4%). Prior upper abdominal surgery, intraoperative finding of a contracted and thick-walled gallbladder (GB), empyema GB, Mirizzi’s syndrome, cholecysto-enteric fistula, and a prior endoscopic common bile duct stone clearance were significant predictors of conversion. Xanthogranulomatous cholecystitis was found more commonly (43% vs 5%) in the conversion group.Conclusion: Conversion to an open procedure during LC should always be treated as an integral component of sound judgement to achieve the safest outcome in a particular patient. Due consideration of pre-operative and intra-operative factors predictive of a higher chance of conversion assists pre-operative patient preparation and counseling as well as surgical planning, conduct and mentoring of residents-in-training.

Acute Cholecystitis Complicating Cardiac Disease: A Cohort Study From a Tertiary Care Center in Mexico City, Mexico.

Background Acute cholecystitis (AC) presents as inflammation of the gallbladder, predominantly attributed to gallstones obstructing the cystic duct. Another notable etiology is ischemic cholecystitis, often stemming from severe illnesses that compromise blood flow to the splanchnic system. Individuals with pre-existing cardiovascular conditions or undergoing cardiopulmonary surgery encounter elevated risks of gastrointestinal pathology, leading to heightened morbidity and mortality rates. In these cases, AC stands out as a significant concern, whether it originates from gallstones or is acalculous (ischemic). Methods We conducted a single-center, retrospective cohort study at the National Medical Center in Mexico City, Mexico. We included demographic, clinical, laboratory, preoperative, intraoperative, and postoperative data. Our main objectives were to describe the characteristics of our population and identify predictors of major complications following surgery for AC in patients with heart disease. Results Our study encompassed 18 patients diagnosed with both AC and cardiac disease, with acute myocardial infarction being the leading cause of admission, constituting 38.9% of cases. The clinical presentation was characterized by right hypochondrial pain, observed in all patients, while Murphy's sign was evident in 44.4% of cases. Additionally, various non-specific symptoms were present in varying percentages across the patient cohort. Concerning imaging studies, 88% of our cohort underwent ultrasound (USG), while computed tomography (CT) was utilized in 55% of patients. Among those who had USG, the most prevalent findings were gallbladder wall thickening in 56% and perivesicular fluid in 37.5%. In patients who underwent CT scans, the predominant observations included perivesicular fluid in 66% and perivesicular fat stranding in 55%. In terms of intraoperative findings, gallbladder empyema and necrosis were the most common findings identified in 55.6% of the cases. After surgery, 61.1% had no complications or developed mild complications, while 11.1% experienced moderate to severe complications without resulting in death; the mortality rate was 27.8% in our cohort. Overall, major complications or death were present in 38.9% of our cohort. In the postoperative data analysis, the use of mechanical ventilation and vasopressors showed a significant correlation with increased morbidity and mortality. Conclusions Our study contributes valuable information to the international literature, providing insights into the complications faced by the Mexican population in the context of heart diseases, particularly among patients suffering from cholecystitis. Within individuals with cardiac disease, the occurrence of AC requiring surgical intervention is associated with heightened morbidity and mortality rates, with our cohort experiencing rates as high as 38.9%. Consistent with findings in the international literature, these results underscore the critical importance of continuing the search for novel clinical or laboratory predictors for this high-risk population. While most parameters assessed in this study did not show any correlation with major complications, exceptions were observed in postoperative vasopressors and mechanical ventilation.

Comparison of quality of life between pre- and post-operative standard laparoscopic cholecystectomy using Short Form-36

Background: Gallstone disease (cholelithiasis) is a wide spectrum of conditions, ranging from asymptomatic cholelithiasis, biliary colic, empyema gallbladder, and gangrene to perforation and peritonitis. Aims and Objectives: The aim of this study was to assess the quality of life before and after a standard laparoscopic cholecystectomy (LC) using the Short Form-36 (SF-36). Materials and Methods: In the study cohort of 100 patients using SF-36 in patients of pre-operative and post-operative standard LC are compared in eight domains of health quality index in Maharani Laxmi Bai Medical College, Jhansi between January 2021 and June 2022. Results: There is finding of significant change in seven domains in mean±1 month, (1) Physical functioning – pre-operative and post-operative, that is, 33.00±31.812 and 88.68±22.40, respectively, (2) Role limitations due to physical health – pre-operative and post-operative, that is, 3.5±18.401 and 98.75±10.546, respectively, (3) Role limitations due to emotional problems – pre-operative and post-operative, that is, 4.67±21.128 and 98.67±11.489, respectively, (4) Energy/fatigue- pre-operative and post-operative, that is, 34.94±16.638 and 83.11±12.456, respectively, (5) Social pre-operative functioning – pre-operative and post-operative, that is, 39.38±20.428 and 98.88±5.196 respectively, (6) Pain – pre-operative and post-operative, that is, 34.73±18.340 and 97.30±15.489, respectively, (7) General health – pre-operative and post-operative, that is, 35.85±35.897 and 67.00±35.511, respectively, and minimal change in one domain (8) Emotional well-being – pre-operative and post-operative, that is, 34.16±15.491 and 39.08±18.694. Conclusion: The pre-operative and post-operative parameters of the SF-36 questionnaire show a significant change in their mean±standard deviation at 1-month postoperatively following standard LC. The maximum significant change occurred in parameters of physical functioning, role emotion, role physical, energy, social functioning, pain, and general health.

Impact of percutaneous cholecystostomy on National Health Service (NHS) service provision and subsequent clinical as well as surgical outcomes.

Abstract Aims To evaluate the impact of percutaneous cholecystostomy on the NHS and clinical/surgical outcomes. Methods Retrospective analysis of patients who underwent percutaneous cholecystostomy between 01/01/2020 to 31/12/2022. Data collected included patient demographics, procedure (indications, mean time for insertion/removal), microbiology (bile aspirate, blood culture), imaging (endoscopic retrograde cholangio-pancreatography (ERCP) / tubogram) performed, clinical outcome, number of planned/unplanned follow-ups and difficulty of cholecystectomy. Results The cohort included 33 patients (20 male, 13 female) with mean age of 74 years. Top indications were (1) gallbladder empyema identified on computed tomographic imaging (76%) and (2) being unfit for surgery i.e., significant comorbidities (55%) / septic (30%). Mean time of insertion and removal was 5 and 59 days, respectively. Escherichia coli (67%) was the most common microorganism from bile aspirate. Most (52%) blood cultures showed no growth. Within the initial admission, majority (82%) did not have ERCP and one-third (36%) had a tubogram. In terms of outcome, 14 (42%) subsequently had cholecystectomy, 12 (36%) were discharged, 6 (18%) died and 1 (3%) is awaiting cholecystectomy. There was a mean of 2 follow-ups before patients were discharged from service. Of those who underwent cholecystectomy, 12/14 were done electively, 12/14 were total cholecystectomy and 13/14 were laparoscopic. Mean surgical time was 116 minutes. Conclusions Percutaneous cholecystostomy is an effective treatment/bridging therapy for patients unsuitable for emergency cholecystectomy. It does not reduce time/difficulty of subsequent cholecystectomy. However, it does put a strain on the NHS with regards to length of stay and planned/unplanned follow-ups.

Gallbladder Empyema: A Dreadly Complication of Acute Cholecystitis

Gallbladder empyema is a severe form of acute cholecystitis with additional suppuration with an incidence rate of 6.3%-26.6% and a mortality rate 3%. If not treated promptly, gallbladder empyema can cause complications. Therefore, in this literature review we will discuss gallbladder empyema in more depth and the immediate treatment that must be carried out to avoid complications in patients. In this literature review Schoolar, we conducted a search on the PubMed and Sciencedirect database using the search keyword “gallbladder empyema”, “empyema”, and “gallbladder”. Gallbladder empyema can occur due to bile that cannot be excreted from the gallbladder will cause infection from microorganisms so that the gallbladder becomes full of exudative material in the form of pus, causing acute inflammation. Diagnosis of gallbladder empyema can be done using Ultrasonography and Computed Tomography Scan (CT Scan). Percutaneous transhepatic gallbladder drainage (PTGBD) is a procedure for the initial management of gallbladder empyema before laparoscopic cholecystectomy. If gallbladder empyema is treated immediately, the prognosis is good. If not treated promptly, gallbladder empyema can lead to peritonitis, and bacteremia leading to a rapid systemic inflammatory response, shock, and sepsis.

Comparison Between Chlorhexidine Gluconate and Povidone Iodine In Preventing Surgical Site Infection In Laparoscopic Cholecystectomy

Surgical site infection is one of the major postoperative complication resulting in an increase in both morbidity and mortality of the patient. Preoperative patients body surface preparation is one of the major factors in preventing surgical site infection. In this study we compared povidone iodine usually used disinfectant with chlorhexidine gluconate for surgical site infection&#x0D; MATERIALS &amp; METHODS&#x0D; It was a cross sectional study conducted at General Surgery ward Gulab Devi Hospital Lahore from January 2021 to December 2022. A total of 200 patients undergoing laparoscopic cholecystectomy were included in this study through purposive sampling and then divided into two groups using lottery methods. In Group A peroperative patients skin preparation was done with 10% povidone iodine while in Group B 4% chlorhexidine gluconate was used for skin preparation. Patients with empyema gall bladder, gall bladder or gut perforation and laparoscopic procedures converted to open were excluded from this study.&#x0D; RESULTS&#x0D; In this study mean age of 45.8 ± 10.3 years with range from 25 to 65 years. In Group A mean age was 45.7 ± 10.8 years while in group B it was 45.8 ± 9.8 years. In Group A 12% wound infection was documented while in Group B it was only 4% (P-value 0.03).&#x0D; CONCLUSION&#x0D; Many antiseptic solutions are used for patient skin preparation before surgery which includes chlorhexidine gluconate, povidone iodine and alcohol. Among these solutions povidone iodine solution is commonly used. In our study we compared povidone iodine with chlorhexidine gluconate solution which showed less surgical site infection which shows chlorhexidine gluconate solution can be safely replaced with povidone iodine solution for skin preparation.

Cholecystitis Complication : Gallbladder Empyema and Hydrops

Acute cholecystitis, or acute inflammation of the gallbladder, is commonly caused by gallstone obstruction. The two major complications that can arise are empyema and hydrops of the gallbladder. Gallbladder empyema is defined as the accumulation of pus in the gallbladder, resulting from prolonged bacterial infection. On the other hand, hydrops of the gallbladder is a condition where serous fluid accumulates in the gallbladder, typically due to chronic obstruction. This article provides an overview of both conditions, including their etiology, clinical manifestations, pathophysiology, diagnosis, and treatment. Emphasis is placed on the importance of early diagnosis and appropriate management to minimize morbidity and mortality. The prognosis for hydrops and gallbladder empyema is influenced by factors such as age and underlying health conditions.

DETERMINANTS THAT PREDISPOSE TO CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY IN A TERTIARY HEALTH-CARE CENTER IN INDIA

Objectives: The aim of this study was to analyze the patient and disease-related factors of gallstone disease and also to identify pre-operative clinical, laboratory, and ultrasonic predictors that predispose to conversion of laparoscopic to open cholecystectomy. Methods: The study was prospectively conducted over 1-year duration in a tertiary care center in India. Demographic, hematological, and radiological data were recorded for all participants and compared to assess predictors of conversion from laparoscopic to open cholecystectomy. Results: A total of 526 patients participated in the study. Thirty-two cases were converted to open with 6.08% conversion rate. The common intraoperative causes of conversion were frozen Calot’s triangle, dense adhesions, and empyema gallbladder. The significant predictors of conversion were found to be a previous episode of acute cholecystitis (p=0.003), previous upper abdominal surgery (p=0.001), total leukocyte count (p=0.012) with neutrophils (p=0.005), gallbladder wall thickness &gt;5 mm (p=0.0082), and presence of pericholecystic fluid (p=0.0184). Conclusion: The above-mentioned determinants can be used to predict the chances of conversion in a patient planned for laparoscopic cholecystectomy so that the patient can be counseled regarding the risk of conversion and informed consent can be obtained, and the surgical team can be adequately prepared.

FTP7.11 The role of percutaneous cholecystostomy in the management of acute cholecystitis in critically ill surgical patients, a single-centre experience, UK

Abstract Percutaneous cholecystostomy (PC) is a minimally invasive procedure that aims to stabilise critically unwell patients with acute cholecystitis. Particularly important for poor surgical candidates, PC facilitates therapeutic benefit with fewer complications and allows patient stabilisation before definitive cholecystectomy. A large 2018 study demonstrated the role of PC to be as effective as emergency laparoscopic cholecystectomy, with no significant difference in mortality. There are no UK national guidelines for the safe practice of PC. This study reports the outcomes in patients admitted as emergency cases undergoing PC for acute cholecystitis. This was a retrospective descriptive study evaluating 24 consecutive patients admitted with acute cholecystitis to a tertiary centre, and underwent PC from 1st May 2019 to 27th January 2021. The data was collected and analysed on Microsoft Excel. The mean age of patients was 76.1 (range 56-107 years) and predominantly female (67%). Mean duration of antibiotics therapy was 13.1 (7-24) days. The most common indication for PC was failed antibiotic therapy (16 patients) followed by gallbladder empyema (4 patients) and severe frailty (4 patients), with 21 patients ASA grade III or above. Mean duration for PC drain in-situ was 31.9 (3-164) days. In five patients, the PC drain fell out spontaneously and 9 patients underwent tubogram before removal. Interval cholecystectomy was performed in 7 patients. No patients died during their acute admission. PC is a safe, established technique to manage acute cholecystitis in critically ill and high-risk surgical patients with favourable outcomes. More research to develop guidelines that identifies suitable patients through emergency admission would be beneficial.

Thoracic Segmental Spinal Anesthesia in Patient with Severe COPD in Open Cholecystectomy

Background: Regional anesthesia is preferred in most of the chronic obstructive pulmonary disease (COPD) patients to avoid intra- and postoperative complications related to general anesthesia. Herein we reported a case of empyema gall bladder with severe COPD who went for an open cholecystectomy under thoracic segmental spinal with epidural anesthesia. He had substantial dyspnea on routine household activities (NYHA Class III). He had history of several hospital admissions with acute onset of dyspnea and was treated with bronchodilators and systemic steroids. He had no history of other comorbidity. The patient was scheduled for an emergency laparotomy followed by open cholecystectomy. Postoperative recovery was uneventful allowing the patient to be discharged on the 5th POD.&#x0D; Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 97-100

Percutaneous transhepatic ultrasound-guided gallbladder aspiration: Still a safe option for gallbladder decompression in patients at high surgical risk.

Cholecystitis generally warrants immediate cholecystectomy; however, high-risk patients require non-surgical options for gallbladder decompression. The continuous evolution of endoscopic techniques makes it difficult for clinicians tochoose the best technique for high-risk patients. Here we aimed to show that percutaneous transhepatic gallbladder aspiration, a technique that has fallen into disuse, is a safe and rapid method for gallbladder decompression. In our local database, we identified 48 patients who had undergone transhepatic punctures of the biliary system,34 of whom were excluded because they had received bile duct punctures. The remaining 14 patients had received gallbladder punctures, of whom 9 were considered eligible for analysis. Cases were retrospectively analyzed for technical success, complications, and individual outcomes. Our analysis included 9 patients (3 female, 6 male; median age, 51 years; range, 32-84 years). Underlying malignancy was found in 5 patients, while 4 were in a palliative situation. Underlying infection was found in 8 cases. All punctures were technically successful without complications. In all patients, individual therapy goals were met,including clinical stabilization in palliative situations, stabilization before liver surgery, exclusion of gallbladder empyema and infection in gallbladder hydrops, and avoidance of gallbladder rupture. The white blood cell counts at the day of punction were significantly reduced one week after the puncture (p=0.023). When selecting an appropriate technique for high-risk patients, clinicians should remember that gallbladder aspiration is a feasible and successful bedside procedure in patients at high surgical risk, which does not require an experienced endoscopist.

Histopathological Disease Spectrum of Cholecystectomy Specimen: A Retrospective Observational Study

Background: Gallstone disease is a common surgical problem requiring cholecystectomy. It is known to produce diverse histopathological changes in the gallbladder ranging from acute or chronic inflammation to metaplasias and even malignancies. Objective: The aim of this study was to emphasize the importance of a detailed microscopic examination and to study the range of histopathological lesions in cholecystectomy specimens. Methods: This is a retrospective study of 1200 cholecystectomy specimens received in the Department of Pathology, Jahurul Islam Medical College Hospital (JIMCH) over a period of 6 years from January 2017 to December 2022. Clinical details and histopathological data were retrieved from the records. The variety of histomorphological changes in the resected gall bladder was studied. Results: There were 1200 cases consisting of 516 (43%) males and 684 (57%) females with M;F ratio of 1: 1.33. Maximum number of patients (28.25%) being 41 to 50 years old. Most common clinical symptom were pain in the upper abdomen and right upper back (91.4%). Histopathologically, the most common diagnosis was chronic cholecystitis (66.75%), followed by acute on chronic cholecystitis (26.25%), gangrenous cholecystitis (3.25%), empyema gallbladder (1.5%), mucocele (0.75%), xanthogranulomatous cholecystitis (0.50%) and adenocarcinoma gallbladder (1%). Conclusion: Cholecystectomy performed for a common condition like gallstone disease can result in a diverse and wide spectrum of histopathological lesions ranging from benign diagnosis to an unexpected gallbladder malignancy. The Journal of Ad-din Women's Medical College; Vol. 11 (1), Jan 2023; p 22-25

Prevalence of Gallbladder Cancer in Cases Presented to Tertiary Care Hospital, Retrospective Five-Year Study on Cholecystectomy Specimen

Background: The gallbladder is surgically removed in a cholecystectomy. The prevalence of gallbladder carcinoma is determined by examining cholecystectomy specimens. Gallbladder carcinoma is an extremely unusual condition that affects more women than men. The goal of this study is to find out how common gallbladder cancer is in medical centers over five years. Objective: To determine the frequency and prevalence of Gallbladder cancer (GBC) in tertiary care hospitals over five years Methods: We analyzed the record of 1835 patients who underwent cholecystectomy at our tertiary care center, Mayo Hospital Lahore. Results: Adenocarcinoma was found in only 7 cases (0.4%) out of 1835 cholecystectomy specimens. Gallbladder cancer is more common in females (6, 85.71%) than in males (1 case, 14.78%). Chronic cholecystitis accounted for the majority of the cases (1703, or 92.8%), followed by acute cholecystitis (66, or 3.6%), Xanthogranulomatous, cholecystitis (30, or 1.6%), gangrenous cholecystitis (6, or 0.34%), follicular cholecystitis (3, or 0.016%) and one case (0.05%) each of cholesterolosis, foci of chronic inflammation, hemorrhagic infarction and empyema gallbladder. 13 cases (0.79%) was partially or fully autolyzed. Conclusion: Chronic cholecystitis is the most common disease in cholecystectomy specimens followed by acute cholecystitis, Xanthogranulomatous cholecystitis, gangrenous cholecystitis, follicular cholecystitis, and empyema gallbladder. Gallbladder carcinoma is very rare and more common in females than males.

EGS P18 A Closed Loop Audit on the Management of Acute Cholecystitis During the Covid-19 Pandemic

Abstract Background The definitive management of acute cholecystitis is laparoscopic cholecystectomy on the same admission, if the patient is fit. However, as the Covid-19 pandemic emerged, evidence suggested adverse outcomes for asymptomatic Covid positive patients undergoing surgery, including increased mortality risk. Risks to theatre staff were also highlighted. This prompted changes in guidelines produced by the Association of Upper Gastrointestinal Surgeons (AUGIS) in March 2020, which strongly supported the conservative non-surgical management of acute cholecystitis. Methods This closed loop audit aimed to establish whether patients with acute cholecystitis were managed in accordance with AUGIS guideline changes at our hospital. It also aimed to assess the clinical outcomes of the guideline changes. This retrospective audit focused on patient admissions with acute cholecystitis at our hospital during the 2 peaks of the Covid-19 pandemic. The timeframe of the initial audit was 17th April - 14th May 2020 (4 weeks). The timeframe of the re-audit was 1st - 28th February 2021 (4 weeks). Handover sheets and clinical software were the data sources. The initial audit was presented at the General Surgery departmental clinical governance meeting in September 2020 and formed the educational intervention. Results 24 patients with acute cholecystitis were included in the initial audit, and 25 patients in the re-audit. The initial audit found that 15 patients (62.5%) with acute cholecystitis were managed conservatively with IV antibiotics, 4 patients (16.6%) had a percutaneous cholecystostomy, and 5 patients (20.8%) underwent laparoscopic cholecystectomy during their index admission. Following our educational intervention, the re-audit found that 22 patients (88%) were treated conservatively, 1 patient (4%) had a percutaneous cholecystostomy, and 2 patients (8%) underwent laparoscopic cholecystectomy. The mean length of hospital stay reduced from 5.67 days in the initial audit, to 3.88 days in the re-audit. 30 day readmission rates also reduced from 5 patients (20.8%) to 0 patients (0%). 2 patients aged &amp;gt;60 years died from unrelated causes during their index admission. They had Charlson Comorbidity Index scores &amp;gt;2. Conclusions Management of acute cholecystitis was more compliant with AUGIS guidelines following the educational intervention. Importantly, overall, conservative non-surgical management did not clinically disadvantage patients, and was not associated with the development of complications of acute cholecystitis, such as gallbladder empyema or perforation. Indeed, the re-audit revealed shorter length of hospital stay and lower 30 day readmission rate than the initial audit. For vulnerable patients at risk of serious complications from contracting Covid-19, this certainly had positive implications for wellbeing, reducing exposure to the hospital environment. There were also further beneficial implications for limited bed resources. Our findings, however, suggest that flexibility is required in decision-making in the management of acute cholecystitis. In carefully selected patients, for example younger patients with fewer comorbidities, emergency laparoscopic cholecystectomy might avoid future readmission with serious complications of gallstones, such as ascending cholangitis and pancreatitis. The evidence from our local audit suggests that AUGIS guideline changes may overall benefit and improve the clinical outcomes of patients with acute cholecystitis. However, decisions about management should be in the interests of, and tailored to, the individual patient.